Thank you for your interest in theHealth Policy Research and Translation Fellowship at Brigham and Women’s Hospital!

All fellowship candidates must be ABEM board certified or board eligible before the July 1 fellowship start date. This generally means that fellows will have completed a residency in Emergency Medicine in the US or Canada. We regret that we cannot accept applications from candidates who do not meet this criterion.

Applications will be accepted on a rolling basis, but we highly suggest that all application materials below be received in full before Monday, October 24, 2016 at 5:00 pm ET. Interviews will be scheduled on a rolling basis and may not be available for those who apply later.

Please submit the following items by email only:

1. This application form

2. CV (see last page)

3. Letter of interest

4. Personal statement (see last page)

Please have the following items sent directly from the recommender by email or fax:

5. Three letters of recommendation (one from current residency director or chairman)

Please have the following items sent directly from the institution by mail:

6. Official transcript of USMLE results

Email:

Fax:(617) 264-6848

Mail:Scott Weiner, MD, MPH

Brigham and Women’s Hospital

75 Francis Street, NH-304J

Boston, MA 02115

The chosen candidate must apply separately to the Harvard School of Public Health Masters in Public Health program online at by December 15, 2016.

Please feel free to contact us at (617) 732-4727 or ith any questions about the fellowship or your application.

Scott Weiner, MD, MPH

Fellowship Director

APPLICANT INFORMATION

First Name / Last Name / Suffix (MD, DO, MPH)
Email / Country of Citizenship

Contact Address

Street Address
City / State / Postal Code / Country
Home Phone / Mobile Phone / Fax

EDUCATION AND TRAINING

Undergraduate Education

Institution (City, State/Country) / Dates Attended / Degree, Field of Study

MedicalSchool

Institution (City, State/Country) / Dates Attended / Degree, Field of Study

EM Residency Format

Place an ‘X’ in the appropriate box / PGY 1-3 / PGY 2-4 / PGY 1-4

Internship/Residency/Fellowship

Institution (City, State/Country) / Dates Attended / Specialty

Other Graduate Education

Institution (City, State/Country) / Dates Attended / Degree, Field of Study

LICENSING AND CERTIFICATION

Examinations (include results from all attempts)

USMLE – Step 1 (3 Digit Score) / Date
USMLE – Step 2 CK (3 Digit Score) / Date
USMLE – Step 2 CS (3 Digit Score) / Date
USMLE – Step 3 (3 Digit Score) / Date

Education Commission for Foreign Medical Graduates Certification

Are you certified by the ECFMG? / Yes / No / Not Applicable
If yes, give your ECFMG Number:

Active Medical Licenses

Type / Certificate Number / Valid dates / Issuing Agency

Emergency Medicine Board Eligibility/Certification

Will you be ABEM board eligible or certified in emergency medicine by July 1 of next year? / Yes / No
If no, please explain:

CURRICULUM VITAE

Send your CV as a separate email attachment. Be sure to include awards, honors, and publications in your CV. List research, work, volunteer, leadership roles and significant health policy experiences with dates (month and year) and nature of your involvement.

PERSONAL STATEMENT

Send your personal statement as a separate email attachment. Include your name at the top of the page. Please limit your personal statement to one single-spaced page, 11 point font or larger, 1” margins. In drafting your personal statement, consider the following:

  1. What parts of emergency care interest you and why? How do you hope to use health policy to influence emergency care or vice versa?
  1. Describe at least one research project you would like to complete during your fellowship.
  1. Where do you see yourself in five years?